不同亚型多囊卵巢综合征不孕患者的临床特征及与体外受精-胚胎移植治疗结局的关系  

Association of the clinical characteristics and the IVF-ET outcome in infertile women with polycystic ovarian syndrome of different subtypes

作　　者：李敏[1] 宋娟[1] 陈士岭[1] 罗琛[1] 倪运萍[1] 王庆玲[1] 郑海燕[1] 伍芳容[1] 

机构地区：[1]南方医科大学南方医院妇产科,广东广州510515

出　　处：《南方医科大学学报》2009年第2期224-227,共4页Journal of Southern Medical University

基　　金：国家自然科学基金(30470657);广东省自然科学基金(04020416);国家重点基础研究发展规划课题(973课题)(2007CB948104)

摘　　要：目的分析不同亚型多囊卵巢综合征(PCOS)不孕患者临床特征及体外受精-胚胎移植(IVF-ET)治疗结局,并探讨其相互关系,以期对PCOS不孕患者的临床诊治提供参考。方法根据2003年鹿特丹专家会议提出的PCOS诊断标准,对2005年1月～2008年1月在南方医院生殖医学中心接受IVF-ET治疗的PCOS不孕患者189例分为3个亚型:I组:PCO+稀发排卵/无排卵+高雄激素临床/生化表现,共54例,行IVF-ET新鲜周期58个;Ⅱ组:PCO+稀发排卵/无排卵,共117例,行IVF-ET新鲜周期126个;Ⅲ组:PCO+高雄激素临床/生化表现,共18例,行IVF-ET新鲜周期18个;回顾性分析各组患者临床特征及IVF-ET治疗结局的关系,比较3组之间的差异性。结果I型组和Ⅲ型组的基础T浓度高于II型组,差异有统计学意义(P<0.05),不同亚型组的其他基本临床特征无显著差异(P>0.05);I型组Gn起始量较其他两组增加,I型组和Ⅲ型组获卵率降低,差异有统计学意义(P<0.05);Ⅰ组和Ⅲ组正常受精率较II组降低,但差异无显著性(P>0.05);3组卵裂率差异无显著性(P>0.05),各组的取消移植率、生化妊娠率无显著差异;I组胚胎着床率、临床妊娠率、继续妊娠率和单个取卵周期累积妊娠率较其他两组降低;I组和Ⅲ组胚胎丢失率、自然流产率较Ⅱ组升高,但差异不显著(P>0.05);Ⅰ组和Ⅲ组的卵巢过度刺激综合征发生率增加,差异显著(P<0.05)。结论鹿特丹诊断标准的分型方法反映了疾病的基本特征,各型PCOS不孕患者接受IVF治疗的临床结局相似,而I型和Ⅲ型PCOS不孕患者的早期胚胎丢失和自然流产率升高,推测可能与体内过多的雄激素影响了胚胎的继续发育潜能有关。Objective To investigate the association of the clinical characteristics and the outcome of in vitro fertilization arid embryo transfer （IVF-ET） in infertile women with polycystic ovarian syndrome （PCOS） of different subtypes. Methods A total of 189 infertile women with PCOS undergoing IVF-ET were enrolled in this study. According to Rotterdam PCOS diagnosis criteria, the patients were classified into 3 PCOS subtypes, namely type Ⅰ with PCO ultrasonography and oligo-ovulation/anovulation and hyperandrogenism （54 women, for whom 58 fresh IVF-ET cycles were performed）; type Ⅱ with PCO ultrasonography and oligo-ovulation/anovulation （117 women with 126 cycles）; type Ⅲ with PCO ultrasonography and hyperandrogenism （18 women with 18 cycles）. The number of retrieved oocytes, fertilization rate, implantation rate, clinical pregnancy rate, spontaneous abortion rates and incidence of ovarian hyperstimulation syndrome （OHSS） were compared between the 3 groups. Results Except for the baseline serum T concentration in the early phase of menstrual cycle, which was significantly higher in groups Ⅰ and Ⅲ than in group Ⅱ, no significant difference was found in the clinical characteristics between the 3 groups （P〉0.05）. Group Ⅰ had the highest initial Gn dose, and the oocyte retrieval rates were significantly lower in groups Ⅰ and Ⅲ （P〈0.05）. The patients in group Ⅰ had lower implantation rate and the clinical, on-going and cumulative pregnancy rates than groups Ⅱ and Ⅲ, but the differences were not statistically significant; the embryo early loss rate and spontaneous abortion rate appeared to be higher in groups Ⅰ and Ⅲ （P〉0.05）. Significantly elevated incidence of OHSS were noted in groups Ⅰ and Ⅲ （P〈0.05）. Conclusion The women with different PCOS subtypes according to the Rotterdam criteria all have similar IVF-ET outcomes, and the increased embryo loss rate and spontaneous/ abortion rate in groups Ⅰ and Ⅲ might be associated with excessive and

关 键 词：多囊卵巢综合征 体外受精 胚胎移植 临床结局 

分 类 号：R711.75[医药卫生—妇产科学] R711.6[医药卫生—临床医学] R714.8